Provider Demographics
NPI:1922464031
Name:SCHOOL STREET SPEECH, LLC
Entity Type:Organization
Organization Name:SCHOOL STREET SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:R
Authorized Official - Last Name:NORDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:224-628-5461
Mailing Address - Street 1:143 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2026
Mailing Address - Country:US
Mailing Address - Phone:224-628-5461
Mailing Address - Fax:844-965-9865
Practice Address - Street 1:143 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2026
Practice Address - Country:US
Practice Address - Phone:224-628-5461
Practice Address - Fax:844-965-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1700259439OtherINDIVIDUAL PROVIDER NPI NUMBER (TYPE 1)